Doctor's note? It might cost you
When Jill Wolfson called the psychiatrist last year for a prescription refill for her son, she had an unpleasant surprise. Up until then, the over-the-phone refill had been free. This time, she was charged by her doctor for the service, to the tune of $25.
"I was really astounded," says Wolfson, of Santa Cruz, whose son had long been seeing this psychiatrist for attention deficit disorder. "We go in for regular checkups to get his meds looked at, so it's not like we call in for refills without ever seeing him. It just seems like it should be part of the service when you're being charged $100 an hour."
Ching, ching! Doctors -- particularly primary care doctors -- are increasingly billing for services that patients have long expected to get gratis: prescription refills, photocopies of medical records, phone consultations, family medical leave forms, medical disability forms, waivers of insurance premiums, waivers for handicapped plates.
Automotive forms. And life insurance premium forms.
Travel insurance forms.
And now, e-mail responses.
The practice, almost unheard of five years ago, has disgruntled some patients and is starting to come to the attention of consumer advocates, who denounce it as one more sign of a broken-down medical system.
"It shows that healthcare is like any other enterprise: It is revenue-driven," says Arthur Levin, director of the New York City-based Center for Medical Consumers. "The system is moving further and further away from being a public good to one in which the physicians are mere shopkeepers. How many times can they ring up the register?"
Even many physicians admit being uneasy about what they themselves refer to as "nickel-and-diming." And those who have so far bucked the trend suggest it is only a matter of time before they join the crowd.
"We think about it a lot," says Dr. Yul Ejnes, an internist in group practice in Cranston, R.I. So far, he says, "We've chosen not to do it, for the same reason we don't do a lot of things: We don't want to offend our patients."
But many doctors see the practice as a necessary evil in times of increased business costs, flat incomes and declining reimbursement from insurance companies -- and the lack of a way to bill those companies for services that don't involve face-to-face patient visits.
